SUMMARY. A study was made in Kuwait of forty minor burn
patients treated as out-patients from February 1994 to April 1995 (27 males/13 females;
mean age 19 yr ; age range 1-47 yr). Twenty-six patients sustained scalds, five flame
burns, five contact burns, and four had electric flash burns, The extent of burn ranged
from I to 12% total body surface, mainly involving the lower limbs. Thirty-eight patients
sustained dermal burns and two had minimal full-thickness burns. The burn wounds were
treated with topical Solcoseryl'.* Solcoseryl dressing was easy to use, comfortable, and
well tolerated by the patients. The spontaneous wound heating in 7 to 29 days (mean 18
days) conformed to initially assessed burn depth in the majority of patients. The
favourable healing showed that no post-injury deepening of the burn wound had occurred.
The incidence of hypertrophic scarring was comparatively less in Solcoseryl-treated
patients. Solcoseryl is therefore is a good topical agent for the management of minor burn
wounds.

Introduction

The management of the burn wound is aimed
at prevention of infection and at the arrest of impending tissue necrosis, so that healing
ensues favourably in partial-thickness burns. Superficial partial-thickness burns heal
within two weeks without scarring, but deep partial-thickness burns are often problematic.
The problem is aggravated by the inherent tendency of these burns to deepen during the
first three days post-injury and become infected, developing hypertrophic scars. A healing
time extending beyond the third week postburn leads to abnormal scar formation. Wound
dressing plays an important role in burn patients in whom spontaneous healing is
anticipated. An ideal wound dressing should be easy to apply and remove, stay in place,
relieve pain, protect from infection, ntinitnize disruption of the wound bed, encourage
re-epithelialization, and be cost-effective. The search for an ideal dressing continues,
in burn wound care.
Solcosery10 is a chemically and biologically standardized protein free nonantigenic and
noripyrogenie dialysate of blood from healthy veal calves. It contains a broad spectrum of
low molecular organic and inorganic substances which help in wound healing by normalizing
metabolic disturbances and tissue damage associated with stress injury and hypoxia. The
action of Solcoseryl increases oxygen uptake by cells, stimulates ATP synthesis, improves
glucose transport, stimulates collagen formation, and promotes angiogenesis. Solcoseryl
has a capacity to speed up the return of reversibly damaged cells to their normal state by
growth-factor-like activity and cytoprotective effects. Skin wound healing is a
combination of cellular and hormonal reactions with scar formation, and scar quality
depends on the harmony of the cellular and hormonal reactions. Hypertrophic scar formation
is quite common after burns and the use of Solcoseryl is claimed to reduce scarring by
balancing the cellular and hormonal reactions. This study was undertaken to evaluate the
role of Solcoseryl in burn wound management.

Material and methods

Forty minor burn patients who from
February 1994 to April 1995 attended Al-Babtain Centre for Plastic Surgery and Burns
(Kuwait) within 24 h post-burn were included in this study. The burn area was mapped out
according to the Lund and Browder chart. Burn depth was judged on the basis of various
clinical criteria. After initial burn wound swabs had been taken, the area was covered
with Solcoseryl and gauze and then bandaged. All patients were treated as out-patients.
The dressing was inspected every day and changed if needed - otherwise it was routinely
changed on alternate days until complete healing occurred. WouDd swabs were taken twice a
week as a part of microbial surveillance. Subjective comments of pain, ease, comfort and
tolerance of dressing, as well as objective assessment of the wound condition, swab
results and the healing process, were recorded twice a week until complete. Once the
wounds had healed, they were reviewed every month for a period of six months to assess
scar quality, and photographic records were taken.
The findings were recorded on standardized forms and analysed by age, sex, cause, extent
and depth of burn, comfort, ease of use, tolerance, allergies, healing duration, and scar
quality in all patients.

Results

Twenty-seven male and thirteen female
patients with a mean age of 19 yr (range 1-47) were studied (Table I).

Age
(years)

Male

Fernale

Total

<= 5

6

6

12(12%)

6- 15

5

1

6(15%)

16-40

15

6

21 (52.5%)

> 40

1

-

1 (2.5%)

Total

27(67.5%)

13 (32.5%)

40(100%)

Table
I - Age and sex distribution

Twenty-six patients sustained scalds, five
flame burns, five contact burns, and four had electric flash burns. The extent of burn
varied from <=1-12% total body surface area (TBSA), although the majority of patients
sustained :<= 5% burns (Table II).

Depth
of burn

Percentage
of burn

<=5

6-10

>10

Total (%)

Superficial
dermal

15

6

2

23 (57-5%)

Deep dermal

4

1

-

5(12.5%)

Mixed dermal

9

1

-

10(25.0%)

Full
thickness

2

-

-

2(5.0%)

Total

30 (75.0%)

8 (20.0%)

2 (5.0%)

40(100%)

Table II
- Severity of burn

Thirty-eight patients presented dermal
burns and two had full-thickness burns. In the patients who sustained full-thickness
burns, the extent was less than 1 %. The body parts involved are depicted in Table III
- the majority of patients (70%) sustained limb burns. Thirtyseven patients reported
that use of Solcoseryl caused no pain and that it was quite a comfortable dressing, while
three commented otherwise. The application and removal of Solcoseryl were easy - the
dressing did not smell abnormal, and it was easy to observe the healing process. The wound
swab results showed colonization of organisms in thirteen patients, but no clinical
infection occurred in any of them. No allergic reaction occurred during the course of
treatment.

The superficial dermal burns (Fig. 1) healed
in about 11 days, mixed dermal burns (Fig.2) in 19 days, and deep dermal and
full-thickness burns (Fig. 3) in 23 days. Thirty-six patients had acceptable scars
while four developed hypertrophic scars. Two patients who developed hypertrophic scars had
full-thickness burns, which took more than three weeks to heal. Hypopigmentation was
observed during follow-up in four patients, and hyperpigmentation in eight. There was no
incidence of post-burn contracture and the scars remained stable in all the patients.

Fig.
la - Second-degree superficial burn in left foot and toes.

Fig.
lb - Healed area showing dyschromia.

Fig.
2a - Mixed burn in right thigh and leg.

Fig.
2b - Appearance after three weeks of Solcoseryl treatment.

Fig.
3a - Burn in right arm, mostly deep second-degree deep.

Fig.
3b - After two weeks of Solcoseryl treatment.

Discussion

All wound care techniques require planned
regular dressing changes, although the interval may vary. Each area of the burn should be
washed and debrided thoroughly with each dressing change. It is comfortable for patients
if a topical agent can be applied and removed easily, causes no pain, is odour free, and
stays on for a long time: we found Solcoseryl altogether acceptable in this regard.
Healing of the burn wound, which depends mainly on its depth and the presence or absence
of sepsis, is a cornplex pathophysiological process also affected by a series of other
multiple factors such as nutrition, temperature, humidity, circulation, mechanical
disturbance, and various growth factors. The burn area has three distinct zones: a central
zone of coagulative necrosis, a surrounding middle zone of stasis, and an outer zone of
hyperaemia. Progressive dermal ischaemia, resulting in progressive cell injury and cell
death, is typical of burn wounds for 24-48 h following the thermal insult. Prevention of
progressive ischaemia and its resultant metabolic changes can limit the extent of skin
necrosis to the zone of coagulation, and this either prevents or limits deepening of the
burn wound.' The comparison in this study between wound healing time and clinically
assessed depth shows that the majority of our patients healed in the anticipated period.
This reflects the fact that there was no deepening of the burn wound when topical
Solcoseryl was used. The improvement of tissue oxygenation by Solcoseryl presumably
prevented deepening of the burn wound. The deep dermal burn, and also the smaller
full-thickness burn, healed in a reasonable period. This favoured healing can be
attributed to good cell oxygenation, improved microcirculation, preservation of cell
membrane integrity, and maintenance of the remaining skin appendages caused by Solcoseryl.
The study does not suggest that healing occurred faster. We observed in most patients a
healthy-looking wound and favoured epithelialization. The incidence of hypertrophic
scarring was low in Solcoseryl-treated patients, which may be due to the healthy-looking
granulation, the favoured epithelialization, and the balancing of the cellular and
hormonal reactions. Scar quality was good, as can be seen in most of our patients (Figs.
1,2). The incidence of post-healing pigmentary disorders was considerable (30%) in this
study.
Solcoseryl is easy to use, comfortable for the patient, and good for wound healing. It is
therefore recommended in minor burns.